The influence of laboratory-induced Meld score differences on liver allocation: more reality than myth.

[en] Background: Liver allocation in Eurotransplant (ET) is based on the MELD score. Interlaboratory MELD score differences in INR and creatinine determination have been reported. The clinical implication of this observation has not been demonstrated. Methods: MELD scores were calculated in 66 patients with liver cirrhosis using bilirubin, creatinine, and INR analyzed in six liver transplant centers. Based on allocation results of ET, patients transplanted from December 2006 to June 2007 were divided according to MELD score in four groups. For each group, the influence of the match MELD on the probability of receiving a transplant was studied (Cox proportional hazards model). Results: Laboratory-dependent significant differences in MELD score were demonstrated. Cox proportional hazards model showed a significant association between MELD score and the probability of organ allocation. The unadjusted hazard ratio for receiving a liver transplant was significantly different between group 2 and group 4 (group 2: MELD 19–24; group 4: MELD > 30). Conclusion: Laboratory-dependent significant differences in MELD score were observed between the six transplant centers. We demonstrated a significant association between the MELD score and the probability of organ allocation. The observed interlaboratory variation might yield a significant difference in organ allocation in patients with high MELD scores.

Disciplines :

Gastroenterology & hepatology

Author, co-author :

Schouten, J. N.

Francque, S.

Van Vlierberghe, H.

Colle, I.

Nevens, F.

DELWAIDE, Jean ; Centre Hospitalier Universitaire de Liège - CHU > Gastro-Entérologie-Hépatologie

Adler, M.

Starkel, P.

Ysebaert, D.

Gadisseur, A.

More authors (4 more)

Language :

English

Title :

The influence of laboratory-induced Meld score differences on liver allocation: more reality than myth.

Publication date :

January 2012

Journal title :

Clinical Transplantation

ISSN :

0902-0063

eISSN :

1399-0012

Publisher :

Blackwell Publishing, Oxford, United Kingdom

Volume :

Issue :

Pages :

62-70

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 18 January 2012

Statistics

Number of views

90 (3 by ULiège)

Number of downloads

215 (1 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

Bibliography

Wiesner R, Edwards E, Freeman R et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003: 124: 91.
Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, Ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology (Baltimore, MD) 2000: 31: 864.
Said A, Williams J, Holden J et al. Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease. J Hepatol 2004: 40: 897.
Heuman DM, Mihas A. Utility of the MELD score for assessing 3-month survival in patients with liver cirrhosis: one more positive answer. Gastroenterology 2003: 125: 992. author reply 4-5.
Gheorghe L, Iacob S, Iacob R, Gheorghe C, Popescu I. Variation of the MELD score as a predictor of death on the waiting list for liver transplantation. J Gastrointestin Liver Dis 2007: 16: 267.
Ferraz-Neto BH, Hidalgo R, Thome T et al. Analysis of Model for End-Stage Liver Disease (MELD) score in a liver transplantation waiting list. Transpl Proc 2007: 39: 2511.
Botta F, Giannini E, Romagnoli P et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut 2003: 52: 134.
Freeman RB, Wiesner RH, Edwards E, Harper A, Merion R, Wolfe R. Results of the first year of the new liver allocation plan. Liver Transpl 2004: 10: 7.
Brown RS Jr, Lake JR. The survival impact of liver transplantation in the MELD era, and the future for organ allocation and distribution. Am J Transplant 2005: 5: 203.
Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology (Baltimore, MD) 2007: 45: 797.
Gish RG. Do we need to MEND the MELD? Liver Transpl 2007: 13: 486.
Freeman RB Jr. MELD and liver allocation: continuous quality improvement. Hepatology (Baltimore, MD) 2004: 40: 787.
Everson GT. MELD: the answer or just more questions? Gastroenterology 2003: 124: 251.
Durand F, Valla D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol 2005: 42(Suppl 1): S100.
Cholongitas E, Senzolo M, Triantos C, Samonakis D, Patch D, Burroughs AK. MELD is not enough - enough of MELD? J Hepatol 2005: 42: 475. author reply 8-9.
Cholongitas E, Marelli L, Shusang V et al. A systematic review of the performance of the model for end-stage liver disease (MELD) in the setting of liver transplantation. Liver Transpl 2006: 12: 1049.
Burroughs AK, Marelli L, Cholongitas E et al. Towards a better liver transplant allocation system. Liver Transpl 2007: 13: 935. author reply 7.
Trotter JF, Brimhall B, Arjal R, Phillips C. Specific laboratory methodologies achieve higher model for endstage liver disease (MELD) scores for patients listed for liver transplantation. Liver Transpl 2004: 10: 995.
Kerry ACE, Marelli L, Goodier D, Nair D, Thomas M, Burroughs A. MELD score and creatinine measurements. Clin Chim Acta 2005: 355: A153.
Cholongitas E, Marelli L, Kerry A et al. Different methods of creatinine measurement significantly affect MELD scores. Liver Transpl 2007: 13: 523.
Bzoweu NHV, Sebanc H, Bonacini M, Rabkin J, Doo E. MELD underestimated unless enzymatic creatinie used. J Hepatol 2004: 40(Suppl 2): 40A.
Lisman T, Van Leeuwen Y, Adelmeijer J et al. Interlaboratory variability in assessment of the model of end-stage liver disease score. Liver Int 2008: 28: 1344.
Ravaioli M, Masetti M, Ridolfi L et al. Laboratory test variability and model for end-stage liver disease score calculation: effect on liver allocation and proposal for adjustment. Transplantation 2007: 83: 919.
Poller L, Keown M, Ibrahim S et al. Comparison of local International Sensitivity Index calibration and 'Direct INR' methods in correction of locally reported International Normalized Ratios: an international study. J Thromb Haemost 2007: 5: 1002.
Van Den Besselaar AM, Houbouyan-Reveillard LL, Aillaud MF et al. Multicenter evaluation of lyophilized and deep-frozen plasmas for assignment of the International Normalized Ratio. Thromb Haemost 1999: 82: 1451.
Grau E, Tenias JM, Olaso MA et al. Monitoring oral anticoagulant treatment from plasma stored for up to 48hours and frozen plasma. Haematologica 1999: 84: 633.
Young DS, editor. Effects of Preanalytical Variables on Clinical Laboratory Tests, 2nd edn, AACC Press: Washington, DC, 1997.
Tripodi A, Chantarangkul V, Primignani M et al. The international normalized ratio calibrated for cirrhosis (INR(liver)) normalizes prothrombin time results for model for end-stage liver disease calculation. Hepatology (Baltimore, MD) 2007: 46: 520.
Bellest L, Eschwege V, Poupon R, Chazouilleres O, Robert A. A modified international normalized ratio as an effective way of prothrombin time standardization in hepatology. Hepatology (Baltimore, MD) 2007: 46: 528.
Tripodi A, Chantarangkul V, Primignani M et al. Point-of-care coagulation monitors calibrated for the international normalized ratio for cirrhosis (INRliver) can help to implement the INRliver for the calculation of the MELD score. J Hepatol 2009: 51: 288.
Robert A, Chazouilleres O. Prothrombin time in liver failure: time, ratio, activity percentage, or international normalized ratio? Hepatology (Baltimore, MD) 1996: 24: 1392.